Clinical Judgement
____________ refers to the process by which nurses make decisions based on nursing knowledge (evidence, theories, ways/patterns of knowing), other disciplinary knowledge, critical thinking, and clinical reasoning”
Clinical Judgement
A person who supports or publicly recommends a particular person or policy
Advocate
Before every med pass to verify safety, what do you need to do?
Verify two patient identifiers
Your patient has an NG tube. You instruct your patient to do what while you place it?
Swallow water
What does WWW stand for in a URL
World Wide Web
What does clinical judgment tell you to do if you have metoprolol due at 0800 and their blood pressure at 0730 was 94/58?
Hold the metoprolol
Your patient is intubated after a significant stroke and cerebral hemorrhage. The doctors have relayed to family that there is no hope of the patient waking up and having a meaningful awareness. The family does not want to remove life support as they feel this is "murder." What type of consult can you place?
Ethics consult, care consult, social work consult
You scan a medication and the warning comes up that it has not been verified with pharmacy yet. When is it okay to override this warning?
In an emergency situation after closed loop verbal orders
Your patient with a foley catheter goes for a walk in the hallway and hangs the catheter bag on the chest pocket of his gown. What do you do and why?
Hang the catheter bag below the bladder to prevent back filling and UTI
What is the common name for dried plums?
Prunes
You have orders for your patient to give correction insulin while they are NPO for their type II DM. What does your clinical judgement tell you?
You should follow these orders if their blood sugar meets criteria for treatment. Correction insulin for hyperglycemia and long acting basal insulin are still administered while patient is NPO. Only meal coverage insulin is held.
You are working in the ED and have a 1.5 year old child that presents for N/V/D but you note unexplainable bruising on her body that is not over bony prominences. What should you do?
Document bruising, notify physician, place social work consult if necessary or contact CPS if probable suspicion, ask parents for explanation of bruising. If more than one parent, try to ask them separately the cause of bruising. Assess child for any other behaviors or physical findings significant for abuse.
Where can you verify IV compatibilities if you have to hang a secondary IV bag through an already infusing medication?
Lexicomp, micromedex, pharmacy, nursing central
Your patient is reporting pain in their IV line and has a red streak. When you flush the IV, it still draws blood and flushes well. What kinds of meds are appropriate to put through this IV?
None. Suspected phlebitis. The IV needs to be removed.
What is cynophobia?
Fear of dogs
Your patient has an order for IV dilaudid after a total hysterectomy who just came up from PACU 30 minutes ago. You count her respirations and they are 8 breaths/minute and she is arousable but very drowsy. What do you do?
Hold the dilaudid due to sedation and do frequent reassessments of pain and sedation. You could also ask the provider for guidance on alternatives
You have a patient who is discharging on hospice. They want to discharge home but family feels uncomfortable with caring for him. They request he remain inpatient. What is the first step to advocating for this patient?
assess what the needs will be at home and how much the family understands about these needs. Care consults and social work can also be involved to coordinate alternatives
Your patient has an order for IV dialudid to help treat post operative pain. She reports last times he had this she felt light headed and dizzy. What you should you do?
Push the medication slowly and diluted with saline to avoid these side effects
Stool
What is the only edible food that never goes bad, some even discovered in ancient Egyptian tombs that is still edible?
Honey
You overhear your coworker who is training a new grad nurse how to place a foley. She relays the nurse should wear sterile gloves, discard unneeded items in the tray such as the sterile drape, use each wipe only once to not reintroduce bacteria, advanced catheter 1-2 inches passed urine return, and inflate balloon. Which step requires intervention?
You should utilize all sterile items in the kit to ensure sterility and help protect patient from CAUTI
You notice an influx of VAP on your ICU unit and notice that not all staff are following protocol for ventilator care. You advocate for more education for staff. What kind of advocation is this classified as?
Safety
You have an order for an IV antibiotic. Your patient has an 18 G PIV that has blood products transfusing through. How do you go about giving the antibiotic?
Place a second IV. Blood products can not be given into the same line as an antibiotic at the same time. You could also ask pharmacy to retime antibiotic if this is safe to do so.
What space does a pluerex drain?
Pleural space
What was the first, feature-length animated movie ever released? (Hint: Disney movie)
Snow White and the Seven Dwarfs